Introduction: Early-onset epilepsy has a characteristic clinico-etiological spectrum, and poor long-term outcome. As not much information on infantile epilepsy is available from India, we studied the clinico-etiological profile of epilepsy in 1-24-month-old children at a tertiary-care public hospital.

Methods: All infants aged 1-24 month with epilepsy (as per ILAE 2014) presenting between April 2016 to March 2017 were enrolled. Detailed history and examination were done in all.  Developmental assessment was done in all by using Developmental Assessment Scale for Indian Infants (DASII). All patients had an EEG and Neuroimaging (CT/MRI).

Results: 60 infants (40 males) were consecutively enrolled after informed written consent. The mean (SD) age at seizure onset was 4.3 (4.14) months.

Perinatal asphyxia (45%) and Malformations of cortical development (18.3%) were the commonest etiologies; neurological examination was abnormal in 68.3%. An MRI abnormality was present in 76% of infants. 15 patients (25%) had West syndrome, which was symptomatic in the majority (73.3%).

Developmental delay (DQ<70) was the commonest co-morbidity (81.7%); 28.3% had profound delay. Odds of developmental delay were 13-times higher in those with an abnormal neurological examination [OR 13.5 (2.82-64.67), P=0.001], and almost 9-times higher with abnormal neuroimaging [OR 8.9 (2.11-37.9), P=0.003].

Conclusions: Most of the epilepsy in infants <2 years is symptomatic, with sequelae of birth asphyxia as the commonest etiology, which is a potentially preventable entity with good perinatal care. High prevalence of co-morbid developmental delay underscores the need for routine evaluation and early intervention in all high-risk infants.